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More people hospitalized with serious lung problems linked to vaping have been found, Wisconsin health officials reported Friday. Last week, health officials reported eight cases of this strange cluster, all involving teens. The cases now involve teens and young adults. According to the Wisconsin Department of Health Services, 11 cases have been identified (including the cluster of eight), and the state’s disease detectives are looking into seven other possible cases. Officials have not confirmed the cause of these injuries, but they’re explicitly warning residents to not vape, and the CDC has now joined the investigation.

The cases date back to late June. All of the patients have been diagnosed with severe lung damage, and with symptoms such as shortness of breath, fatigue, chest pain, and weight loss. The severity of illness has ranged, with some needing medical assistance to breathe, and while patients have generally improved, it’s still not clear whether they will experience any long term effects.

“We are currently interviewing patients, all of whom reported recent vaping. Our disease investigators continue to gather information about the names and types of vape products that were used in hopes of determining a common link,” said Wisconsin Department of Health Services Secretary-designee Andrea Palm in a statement Friday. “We strongly urge people to avoid vaping products and e-cigarettes. Anyone—especially young people who have recently vaped—experiencing unexplained breathing problems should see a doctor.”

State health officials are now working with the Centers for Disease Control and Prevention on their investigation, a representative for the Wisconsin Department of Health Services told Gizmodo via email. They’ve also notified other states in the event that similar cases may be happening elsewhere.

So far, no common thread besides vaping has been found among the patients. But it’s still unclear exactly how e-cigarettes could be causing these cases, if they are indeed the culprit. Health officials have said previously that patients reported vaping nicotine as well as THC in the weeks and months before their symptoms first appeared.

What is known is that rates of e-cigarette use have skyrocketed among teens in recent years. And while many tobacco control experts and advocates believe that e-cigarettes can be a useful tool for getting traditional tobacco smokers to quit, others have argued that we know little about the short- and long-term health effects of these products.

In response to the explosion in teen vaping, government agencies like the Food and Drug Administration has been forced to speed along the implementation of stricter regulations on these products, while cities such as San Francisco are currently trying to pass strict bans on their public use and sale.